The present invention relates to the medical diagnostic imaging and minimally invasive surgery arts. It finds particular application in conjunction with an integrated CT scanner, fluoroscopic x-ray device, and mechanical arm type minimally invasive type surgical tool and will be described with particular reference thereto. It is to be appreciated, however, that the invention is also applicable to magnetic resonance imaging and other imaging systems capable of generating volumetric images. The system is also applicable to other real time imaging systems capable of monitoring a region of the patient during a minimally invasive surgical procedure. The invention is also applicable to performing surgical procedures with minimally invasive surgical instruments whose position is monitored using electronic triangulation techniques rather than a mechanical arm.
Heretofore, volumetric image data of patients have been generated using CT scanners, magnetic resonance imagers, and the like. The 3D image data has been used to plan minimally invasive and other surgical procedures. However, the bulky size of the CT scanners and magnetic resonance imagers, the data acquisition time, radiation in CT scanners, strong magnetic fields in magnetic resonance imagers, and the like, render such imagers inconvenient for monitoring minimally invasive or other surgery in real time. More typically, a minimally invasive procedure might be planned based on such diagnostic images and carried out at a later time.
At one or more points during the invasive procedure, the procedure might be stopped and the patient reintroduced into the imager to determine whether the surgical instrument has reached the target, is following the appropriate trajectory, or the like. Such starting and stopping of the surgical procedure, movement of the patient, and the like is again inconvenient and can introduce error. Moreover, such a system checks the surgical procedure after the fact and does not provide real time monitoring.
Minimally invasive surgical procedures have been monitored using fluoroscopic projection equipment. During the interventional surgical procedure, the surgeon actuates the fluoroscopic equipment from time to time to generate projection images of the region of interest and the surgical instrument. However, in fluoroscopic images, data from the entire subject is projected or compressed into a single plane. This permits the position of the surgical device to be monitored relative to the two axes in the plane of the image but provides limited queues as to the depth in the direction perpendicular to the image. Moreover, fluoroscopic images are typically at relatively low radiation doses and have less resolution than CT or MRI images.
Some interventionalists display images derived from the volumetric data on one monitor concurrently with the display of fluoroscopic images on another monitor. The data on the two images is integrated in the interventionalist's mind. Such mental integration raises the prospect of mental mistake and judgement errors.
The present invention provides a new and improved method and apparatus which overcomes the above-referenced problems and others.